Experts Look for More Answers Regarding Cosmetic Gynecology

The Howard Taylor International Lecture this morning will look at whether there can be consensus in the growing field of cosmetic gynecologic surgeries.

Both debaters during “Cosmetic Gynecology: What Are We Doing?,” which starts at 10:40 am in Hall D, will talk about the different types of genital cosmetic procedures and procedures promoted for sexual enhancement such as labiaplasty, vaginal rejuvenation, and clitoral unhooding. The session also examines the different energy sources used, including lasers, and will include a discussion about research and opportunities for innovation.

Mickey Karram, MD, director of urogynecology and reconstructive surgery at the Christ Hospital and medical director of the Christ Hospital Pelvic Floor Center in Cincinnati, Ohio, said that, as these procedures become more popular, ACOG and its members need to take a leadership role so patients with questions know to turn to their gynecologists for valid information.
Many of these procedures are being done by plastic surgeons, dermatologists, and urologists, and some practices are driven by the profit these procedures can bring.

Dr. Karram, who has been using lasers for some of these procedures for more than two years, said gynecologists should be the leaders in determining which procedures have validity, who should be performing them, and how they should be performed.
“For ACOG and physicians to just turn their backs and say, ‘Oh, this is inappropriate,’ doesn’t really address the problem,” he said.

Mickey Karram, MD

Cheryl Iglesia, MD

Co-debater Cheryl Iglesia, MD, director of the section of Female Pelvic Medicine and Reconstructive Surgery and director of the National Center for Advanced Pelvic Surgery at MedStar Washington Hospital Center, worries that aggressive marketing has outpaced the medical data. Cosmetic gynecology remains an unregulated business with no consensus on technique, nomenclature, training, and certification for these expensive fee-for-service procedures.

That marketing caters to the concept that general media, pornography, and social media are setting standards for what’s “normal.”

“As women’s health specialists, we need to make sure that our patients and everybody understands that there’s a very wide variation of what’s normal,” she said. “There’s not a standard, but I feel like Hollywood and the media are setting standards.”
Drs. Karram and Iglesia are involved in the Vaginal Laser Therapy to Vaginal Estrogen Therapy (VeLVET) clinical trial that compares CO2 fractionated vaginal laser therapy with vaginal estrogen cream therapy for treating vulvovaginal atrophy/GSM.